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Ventricular shunt complications in patients undergoing posterior vault distraction osteogenesis

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Abstract

Purpose

The primary objective of this study is to investigate post-operative morbidity and shunt revision rates of patients with shunt-dependent hydrocephalus (SDH) undergoing posterior vault distraction osteogenesis (PVDO) compared to patients undergoing conventional posterior vault reconstruction (PVR).

Methods

A retrospective case-controlled cohort analysis of all patients with SDH undergoing PVDO and PVR for syndromic or complex craniosynostosis was performed. Demographic information, perioperative variables, distraction protocols, and shunt-related complications—infection, surgical revision of shunt, increased length of stay (LOS), and readmission within 90 days of surgery—were compared using the appropriate statistical tests.

Results

Fourteen patients with ventricular shunts who underwent PVDO and eight patients with shunts who underwent PVR were identified. Shunt-related complication rates were significantly higher with PVDO (n = 5) compared to PVR (n = 0), p = 0.0093. Among the five patients who suffered complications, the most common were shunt infection (n = 4), shunt malfunction (n = 4), and wound infections (n = 3). All patients with complications required additional operations for shunt revision and/or replacement; four patients required multiple takebacks for such procedures, with an average of three additional procedures per patient.

Conclusions

In complex or syndromic craniosynostosis patients who have previously undergone ventricular shunting, PVDO is associated with higher shunt-related complications and need for additional procedures when compared to traditional PVR. While the benefits of PVDO in the treatment of syndromic craniosynostosis are well documented, the risks of PVDO in the face of a VP shunt must be considered. Further investigation into patient-specific risk factors and risk reduction strategies is warranted.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Anthony Azzolini, Katie Magoon, Robin Yang, Scott Bartlett, Jordan Swanson & Jesse Taylor

  2. Perelman Center for Advanced Medicine, South Tower, 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Jesse Taylor

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  1. Anthony Azzolini
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  2. Katie Magoon
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Correspondence to Jesse Taylor.

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Azzolini, A., Magoon, K., Yang, R. et al. Ventricular shunt complications in patients undergoing posterior vault distraction osteogenesis. Childs Nerv Syst 36, 1009–1016 (2020). https://doi.org/10.1007/s00381-019-04403-w

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  • DOI: https://doi.org/10.1007/s00381-019-04403-w

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